PANIC DISORDER

Panic Disorder is a type of anxiety disorder that is characterized by repeated episodes of sudden, overwhelming terror that peaks in intensity around ten minutes after symptom onset. These episodes of unexpected panic are better known as panic attacks. In order to be diagnosed with Panic Disorder, a person must experience at least one panic attack followed by a one-month period in which one or more of the following happens:

  • Worrying about having additional panic attacks.
  • Worrying about the outcome of having another panic attack, such as having a heart attack or crashing the car.
  • Changing his/her behaviours in an attempt to minimize the chances of experiencing another panic attack. One example is avoiding driving if he/she had the panic attack while driving.

Repeated panic attacks due to substance use, medical conditions (Example: hyperthyroidism), or Specific Phobias are not considered symptoms of Panic Disorder.[1]

Agoraphobia develops with chronic occurrence of panic attacks. Agoraphobia is an 1) intense fear of public places in which a person might be embarrassed or from which escape might be difficult (Example: a bus or train) or 2) an intense fear of having a recurring panic attack where he/she previously experienced a panic attack.[2]

  • It can develop anytime but commonly in late adolescence or early adulthood.[3]
  • It affects between 0.5% and 1% of the population, according to 2005 statistics. Each year, Agoraphobia develops is about 2 in every 1000 people and the lifetime occurrence rate in Canada is 1.5%. Women are more likely to be affected than men.[4]

Canadian Statistics

  • According to the 2015 statistics, Panic Disorder is much more common in women than men; among women, the rate is 4.6% compared to 2.8% for men. It can appear at any age but it begins most often in young adults. It often occurs after a period of considerable stress (Example: work overload, loss of a loved one, move to a new city, a serious accident, surgery, a divorce).[5]
  • Around the world, it is predicted that 3 out of 100 people will suffer Panic Disorder at some point in their lives; it rarely goes away by itself.[6]
  • Although 1 out of 3 adults may experience panic attacks in any given year, only 1-2 percent of Canadians in that same year experience Panic Disorder. About 4% of Canadians will experience Panic Disorders in their lifetime.[7]
  • In 2013, almost half of people who had a current Panic Disorder consulted a medical practitioner during the previous year. Women were significantly more likely to seek help than men.7

Behaviours associated with Panic Disorder:

  • Repeatedly going to the doctor or hospital to have heart check-ups
  • Avoiding driving
  • Not going to school or work
  • Avoiding leaving the house in order to minimize the chance of having a panic attack (agoraphobia)
  • Isolating yourself from family and friends
  • Drug use/abuse as a means of managing panic attacks symptoms

Feelings associated with Panic Disorder:

  • Intense fear or terror
  • Anxiety
  • Sense of Urgency
  • Helplessness
  • Embarrassment
  • Sadness

Thoughts associated with Panic Disorder:

  • “I’m going to have a heart attack and die.”
  • “I can’t attend work/school or I will have a panic attack and embarrass myself.”
  • “If I have another panic attack, I am going to go crazy and end up in the hospital.”
  • “I know I’m going to have a panic attack as soon as I leave the house today.”

Panic Disorder and the Body:

Panic Disorder manifests in both mental and physical symptoms. Panic attacks, which are the main components of Panic Disorder, are a highly physical experience and include symptoms such as:

  • Heart palpitations
  • Shortness of breath
  • Shaking or trembling
  • Sweating or chills
  • Muscle weakness
  • Tingly/numb arms or hands

Panic Disorder and the Brain:

One area of the brain that is highly involved with Panic Disorder is the amygdala. Multiple research studies have examined the amygdala and concluded that it is strongly related to emotional responses, especially fear.[8] Other studies have provided evidence for the claim that the size and shape of the amygdala can also influence your likelihood of suffering from Panic Disorder.[9]

Does Psychology Work?

While treating Panic Disorder may require a combination of medical and psychological interventions, there are several psychological treatments that are especially effective at treating Panic Disorder.

  • Cognitive Behavioural Therapy (CBT): focuses on reducing undesirable behaviours or feelings by changing your patterns of thinking. A large component of Panic Disorder is the anxiety and worry that occurs in between panic attacks. These anxious thoughts are a large part of the suffering that occurs with Panic Disorder, making CBT an appropriate intervention. CBT treatment has been clinically shown to perform better at treating Panic Disorder than no intervention, and is considered one of the most effective treatments for this condition.[10] The effectiveness of CBT for panic disorder is limited by high levels of avoidant behaviour, a low expectancy for change, and a high level of impairment due to the disorder.[11]
  • Eye Movement Desensitization and Reprocessing (EMDR): is another treatment for panic disorder that allows you to change your negative perception of a memory of a past event, such as remembering a time that you had a panic attack. Studies of EMDR have shown that it can help reduce the severity of panic attacks.[12]
  • Somatic Therapy: is a more holistic approach to treating panic disorder. This type of therapy teaches you how to recognize and release physical tension in the body. Somatic Therapy includes body awareness, breathing techniques, movement, and sometimes a healing touch.[13] There is research-based evidence that somatic therapies are an effective treatment option, especially when used in addition to other types of therapy.[14]
  • Breathing Exercises: are especially useful treatments for panic disorder because they can help balance the ratios of oxygen to carbon dioxide in the body. When these levels are out of balance, the body’s nervous system has difficulty regulating your heart rate, stress hormones, and levels of muscle tension.[15]

Tips to Help Manage Panic Disorder!

  • Education: The symptoms of Panic Disorder can be frightening, and many people worry that they are experiencing a heart attack. Learning about the symptoms, causes, and prevalence of Panic Disorder can help ease your worries and reassure you that you are not alone.
  • Mindfulness Techniques: Mindfulness is a state of mind that is characterized by a non-judgemental observance of the present moment. Practicing mindfulness can be done through a variety of methods, such as through meditation or yoga. Mindfulness helps ease the symptoms of Panic Disorder by teaching you how to experience uncomfortable feelings without becoming lost in them. It teaches you to be able to tolerate the sensations without feeling overwhelmed.
  • Calm and Controlled Breathing: can help you regulate the hyperventilation that commonly occurs with panic attacks. When you are experiencing a panic attack, your breathing can become shallow and rapid. This can lead to other symptoms that worsen panic, such as chest pain, rapid heartbeat, or tingly arms. Learning various breathing exercises when you are not panicking can help prepare you for a future panic attack. Feeling prepared to handle a panic attack can help ease the worry associated with having future panic attacks.

Your experience of having a Panic Disorder is unique even though there are universal symptoms that all people experience with Panic Disorders. Although you may identify with the symptoms and information on this page, it is possible to experience varying degrees of intensity of the Panic Disorder symptoms. Panic Disorder can also occur at the same time as other mental health conditions, such as depression and trauma. Your treatment plan for managing Panic Disorder should be tailored to your specific goals and therapeutic needs. At Hopewell Psychological, we offer a variety of evidenced-based treatment options, such as CBT and EMDR. We also accommodate therapy for couples, families, and individuals. Improving your interpersonal relationships can help strengthen your support network as you are guided towards recovery for Panic Disorder. Recovery is possible, and we at Hopewell Psychological would love to be a part of your wellness journey.

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*Psychologists are covered under Insurance Companies in Canada. You will need to check with your insurance company about the specific details regarding your coverage.

References

[1] Memon, A. Mohammed. “Panic Disorder.” Medscape. WebMD LLC., 9 Nov. 2016. Web. 22 Apr. 2017.

[2] McIntosh, James. “What is agoraphobia? What causes agoraphobia?” Medical News Today. Healthline Media, 5 Aug. 2015. Web. 22 Apr. 2017.

[3] “‘Psychology Works’ Fact Sheet: Phobias.” Canadian Psychological Association. Canadian Psychological Association, 2015. Web. 22 Apr. 2017.

[4] “Section B: Anxiety Disorders.” Statistics Canada. Statistics Canada, 2015. Web. 22 Apr. 2017.

[5] “Canadian Community Health Survey.” Statistics Canada. Statistics Canada, 2015. Web. 22 Apr. 2017.

[6] “‘Psychology Works’ Fact Sheet: Panic Disorder.” Canadian Psychological Association. Canadian Psychological Association, 2015. Web. 22 Apr. 2017.

[7] “Panic Disorder.” Canadian Mental Health Association. Canadian Mental Health Association British Columbia, 2013. Web. 22 Apr. 2017.

[8] Demenescu, L. R., et al. “Amygdala activation and its functional connectivity during perception of emotional faces in social phobia and Panic Disorder.” Journal of psychiatric research 47.8 (2013): 1024-1031.

[9] Yoon, Sujung, et al. “Subregional Shape Alterations in the Amygdala in Patients with Panic Disorder.” PloS one 11.6 (2016): e0157856.

[10] Hofmann, Stefan G., and Jasper AJ Smits. “Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials.” The Journal of clinical psychiatry 69.4 (2008): 621.

[11] Porter, Eliora & Chambless, Dianne L. “A systematic review of predictors and moderators of improvement cognitive-behavioral therapy for panic disorder and agoraphobia.” Clinical Psychology Review 42 (2015): 179-192.

[12] McIntosh, A., et al. “Clinical guidelines for the management of anxiety. Management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care.” National Institute for Clinical Excellence (2004).

[13] Khan. K. “How Somatic Therapy Can Help Patients Suffering from Psychological Trauma.” World of Psychology. (2016).

[14] Beutel, Manfred E., et al. “Changes of brain activation pre-post short-term psychodynamic inpatient psychotherapy: an fMRI study of panic disorder patients.” Psychiatry Research: Neuroimaging 184.2 (2010): 96-104.

[15] Caldwell, Christine, and Himmat K. Victoria. “Breathwork in body psychotherapy: Towards a more unified theory and practice.” Body, Movement and Dance in Psychotherapy 6.2 (2011): 89-101.

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